Risk, resilience and vulnerability in children and adolescents in relation to long term conditions: the example of Eastern Europe and Central Asia

Aims. In this study, the authors examine issues for harmful risk taking and adverse risk behaviours among children and adolescents in respect of chronic illness and long-term conditions, such as those brought about through exposure to blood-borne viruses. The example of the position of children and young people in Eastern Europe and Central Asia is given.

Background. Many formidable obstacles exist for public health, education and social work authorities in Eastern Europe and Central Asia. These make interventions and preventive work with children and adolescents with long-term conditions in these countries particularly challenging.

Methods. A survey was conducted by the authors of selected indicators for countries in Eastern Europe and Central Asia, based on data collected in 2009 from secondary sources. Key patterns for adverse risk factors relevant for long-term conditions in these countries, using selected indicators, are analysed. The main elements of a model, the Risk, Resilience and Vulnerability Model, are set out; these are based on the results of previous empirical research by the writers on the topic of risk in the UK and in Eastern Europe and Central Asia, and are combined here in an innovative manner to provide a framework for facilitating developments in theory and practice.

Findings. In the survey of selected indicators, it was found that children and adolescents in Eastern Europe and Central Asia face a range of enhanced risks of an adverse nature. The Risk, Resilience and Vulnerability Model is recommended as a model for forging approaches and programmes across health sectors and settings, including schools, street shelters and penal institutions. It is also contended that the development of middle range theory, such as that underpinning the model, is a valuable resource for fashioning creative and empowering approaches for working with a child-centred, developmental perspective that can bring together diverse agendas.

Conclusions. It is contended that unless and until holistic and cross-sectoral approaches to tackling the problems for children and adolescents with chronic illness and long-term conditions, much time, effort and scarce resources will be wasted through duplication and poor coordination. Programmes that promote more empowering and positive conceptions of risk and risk taking are required when working with children and young people. A model such as the Risk, Resilience and Vulnerability Model encourages such approaches across school, street and young offender settings in risk work with children and adolescents in Eastern Europe and Central Asia.

Relevance to clinical practice. The Risk, Resilience and Vulnerability Model facilitates holistic and cross-sectoral approaches for working with children and adolescents with chronic illness and long-term conditions. Health promoters, educationalists and social care agencies need to work with positive models of risk and to better support children and adolescents by understanding how they perceive risk and through developing their skills and informal coping strategies.

• http://dx.doi.org/10.1111/j.1752-9824.2010.01055.x